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Reducing surgical site infections among paediatric patients undergoing cardiac surgery: a multi-disciplinary quality
Faizah Amer Alnahdi1, Sahar Abdullah Alamro1, Tareq Jamal Alanezi1
1Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia.
Introduction:
Sternal wound surgical site infections (SSIs) in paediatric cardiac surgery are associated with significant morbidity, prolonged hospitalization, and elevated healthcare burden. In response to baseline surveillance at our cardiac centre, between July and December 2024 13 SSIs were identified among 128 open-heart paediatric cardiac surgeries (10.2%), exceeding national and international benchmarks; a structured quality-improvement initiative was implemented to reduce SSI rates and enhance SSI prevention practices.
Methods:
An evidence-based SSI-prevention bundle that included preoperative chlorhexidine gluconate (CHG) preparation, optimal antibiotic selection, dosing, timing, and redosing, standard wound care, sterile delayed sternal closure protocols, and improved environmental cleaning was implemented from January to December 2025 a by a multi-disciplinary team. Plan-Do-Study-Act (PDSA) cycles, statistical process control charts, compliance audits, and mixed qualitative feedback were used to measure impacts. The measures were the SSI rate and bundle adherence reliability. Essential elements include strengthening adherence to perioperative bundle components across all phases; a sterile delayed sternal closure setup; and intensified environmental cleaning consistent with national guidelines, supported by staff education, real-time process and outcome monitoring with feedback, electronic health record prompts, daily audits, and ongoing staff and leadership engagement.
Results:
During the baseline period (July-December 2024), 13 SSIs occurred among 128 paediatric cardiac surgeries (10.2%). After bundle implementation (January-December 2025), eight SSIs were identified among 357 procedures (2.2%); representing a relative reduction of more than 75% in the overall SSI rate with considerable improvements seen in superficial, deep, and delayed-sternal-closure-related infections. Bundle adherence increased from a baseline mean of 37% to 77%, with sustained compliance above 80% from June 2025 onwards.
Conclusion:
A comprehensive, multi-disciplinary SSI-prevention care bundle was associated with reduced paediatric cardiac SSIs and improved care reliability. The approach is sustainable, adaptable to other contexts with appropriate modifications, and provides a practical model for enhancing surgical safety in high-risk paediatric groups.
